Who operates on the children?

An unexpectedly high burden of elective paediatric surgery is being performed by the Ear, Nose and Throat (ENT) surgeons in Moshi, Tanzania. We believe this brief survey demonstrates the capacity for elective paediatric surgery in the sub-Saharan setting, comparable to the elective operative numbers of an equivalent tertiary centre in Liverpool, UK.

Post-operative Complications of Complicated Paediatric Appendicitis in a Tertiary Teaching Hospital

Background: Acute appendicitis is a common surgical problem, with complicated appendicitis having significant post operative complications, which contribute significantly to cost of medical care. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with complicated appendicitis from January 2016 to June 2021. Results: The study had 30.4% surgical site soft tissue infection (SSI). There was 13.48% incidence of major complication, with laparoscopic and open appendicectomies having similar incidence even though not statistically significant. SSI was more common with appendicular abscess and post ileal appendix. Post operative intra-abdominal abscess is more common with open appendicectomy, generalised peritonitis, post ileal appendix and base/proximal perforation of appendix. Post operative adhesive intestinal obstruction was more common with laparoscopic appendicectomy, appendicular abscess and base/proximal perforation of appendix. Total hospital stay correlates significantly with duration of symptoms on presentation with mean hospital stay of 7.72 days. Conclusion: Complicated appendicitis have high incidence of post operative complications, 30.4% SSI and 13.48% serious complications like intra-abdominal collection and adhesive intestinal obstruction. Keywords: Appendicitis, Complication, Surgical site infection, Children.

Prevalence of Paediatric Surgical Conditions in Eastern Uganda: A Cross-Sectional Study

Background The role of surgery in global health has gained greater attention in recent years. Approximately 1.8 billion children below 15 years live in low- and middle-income countries (LMIC). Many surgical conditions affect children. Therefore, paediatric surgery requires specific emphasis. Left unattended, the consequences can be dire. Despite this, there is a paucity of data regarding prevalence of surgical conditions in children in LMIC. The present objective was to investigate the prevalence of paediatric surgical conditions in children in a defined geographical area in Eastern Uganda. Method A cross-sectional study was carried out in the Iganga-Mayuge Health and Demographic Surveillance Site located in Eastern Uganda. Through a two-stage, cluster-based sampling process, 490 households from 49 villages were randomly selected, generating a study population of 1581 children. The children’s caregivers were interviewed, and the children were physically examined by two medical doctors to identify any surgical conditions. Results The interview was performed with 1581 children, and 1054 were physically examined. Among these, the overall prevalence of any surgical condition was 16.0 per cent (n = 169). Of these, 39 per cent had an unmet surgical need (66 of 169). This is equivalent to a 6.3 per cent prevalence of current unmet surgical need. The most common groups of surgical condition were congenital anomalies and trauma-related conditions. Conclusion Surgical conditions in children are common in eastern Uganda. The unmet need for surgery is high. With a growing population, the need for paediatric surgical capacity will increase even further. The health care system must be reinforced to provide services for children with surgical conditions if United Nations Sustainability Development Goal 3 is to be achieved by 2030.

Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

Intussusception is defined by Treves in 1899 as invagination of segment of bowel into adjacent segment usually proximal into distal. It’s a common cause of abdominal emergencies especially in children two years of age and younger. It accounts for 1 in 2000 infants and children and results in intestinal obstruction. Post-operative intussusception is one of the rare etiologies of intestinal obstruction that represents 0.01 to 0.25% after laparotomies and 5 -10% of all early postoperative intestinal obstructions. Our case is a ten years old female presented to the National Center for Pediatric Surgery; Gezira state; Sudan; February 2021 complaining of abdominal distention and constipation for 6 days. She had past history of acute appendicitis due to which she underwent emergency opened appendectomy. Her condition started one day after appendectomy. O/E : patient looks ill, febrile, not pale or jaundice; PR:140b/m; RR:25c/m; abdominal examination show: distended abdomen with full flanks, unhealed lanz incision with small amount of pus discharge; no dilated veins or visible peristalsis; hernia orifice were intact; lower abdomen was tense & tender; no palpable mass; DRE: rectum contains impacted hard stool. Emergency explorative laparotomy was done. Findings: Ileocecal intussusception, bowel was healthy and viable. Simple reduction was done. Conclusion and Recommendations: Post-operative intussusception usually associated with bowel ischemia and necrosis which is not consistent with our case. We highly recommended abdominal ultrasonography, CT scan; when there is a high index of suspicion.

Design and Implementation of a novel Weekend Elective Paediatric Surgery Program to Reduce COVID-19 Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends – Extra Lists (ORRACLE-Xtra) (Preprint)

BACKGROUND The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the healthcare system. Ramp down of surgical services led to significant backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends – Extra Lists (ORRACLE-Xtra). OBJECTIVE Our overall goals were to increase patient access to surgery (and reduce the waitlist), improve operating room efficiencies, and optimize parent and staff experience. METHODS Using the DMAIC framework (define, measure, analyze, improve, control), we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescence of the COVID-19 pandemic and defined process and outcome measures based on provincial targets of out of window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period resulting in a 5 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the weekends. RESULTS ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period resulting in a 5 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the weekends. CONCLUSIONS Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. CLINICALTRIAL N/A

Quality of Telehealth Services in Delivery of Paediatric Surgical Care in Australia: A Systematic Literature Review

Telehealth services are commonly used in many aspects of medicine to improve access to medical care for populations in rural and remote regions, and can and do play an important role in ensuring equitable access to paediatric surgery in Australia’s more rural and remote areas.

Perioperative medicine in paediatric anaesthesia

Perioperative medicine is an expanding field within paediatric surgery. This article gives an overview of the different areas of perioperative medicine throughout the paediatric surgical journey.

Cost-effectiveness of paediatric surgery: an economic evaluation of World Paediatric Project surgical interventions in St. Vincent and the Grenadines (2002–2019)

ObjectivesThe purpose of this study is to examine the cost-effectiveness of six types of surgical interventions as part of a sustained paediatric surgical programme in St.Vincent and the Grenadines from 2002 to 2019.DesignIn this economic model, six paediatric surgical interventions (ophthalmic, orthopaedic, plastic, general, urology, neurosurgery) were compared with no surgery in a deterministic cost-effectiveness model. We assessed health benefits as averted disability-adjusted life-years (DALYs). Costs were included from the programme perspective and measured using standard micro-costing methods. Incremental cost-effectiveness ratios (ICERs) were calculated for each type of surgical intervention. Interventions with ICERs of <50% of gross domestic product (GDP) per capita were considered cost-effective. Costs are reported in 2019 US$. Univariate sensitivity analyses were conducted to assess the effect of uncertainty.ResultsThe average cost per procedure was US$16 685 (range: US$9791.78–US$72 845.76). The cumulative discounted 18-year health impact was 5815 DALYs averted with a cost per DALY averted of US$2622. Most paediatric surgical interventions were cost-effective, yielding cost per DALY estimates less than 50% of GDP per capita of St. Vincent and the Grenadines. When undiscounted, only orthopaedic surgeries had cost per DALY more than 50% GDP per capita. When considering discounting, orthopaedic and urology surgeries exceeded the adopted threshold for cost-effectiveness.ConclusionsWe found that short-term, recurrent surgical interventions could yield substantial economic benefits in this limited resource setting. This research indicates that investment in paediatric surgical interventions is cost-effective for the majority of specialties. These findings are of clinical significance given the large burden of disease attributable to surgically treatable diseases. This work demonstrates that scaling up dedicated surgical programmes for children is a cost-effective and essential component to improve paediatric health.

Children's and Parents' Anxiety Levels pre and post Thoracoplasty. Play Specialist-based Intervention beneficial Outcomes

Paediatric surgery elicits anxiety in children and their parents. The present study tests the impact of Play Specialist-based intervention (PS) on children's and parents' anxiety pre and post thoracoplasty. The study was held at Gaslini pediatric hospital (Genoa, Italy) and involved families with a child undergoing thoracoplasty to correct children's pectus carinatum (PC) or excavatum (PE). Children provided with PS-based intervention (n=40) were compared with control children (n=32). The mothers of PS children (n=40) were compared with the control mothers (n=32), and the fathers of PS children (n=40) were compared with the control fathers (n=32). Visual Analog Scale (VAS) was administered to assess pre and post thoracoplasty anxiety. T-tests and Analyses of Covariance (ANCOVA), Bayes factors for t-tests and ANCOVA were computed. A significant interaction effect between time and group (i.e., PS and controls) emerged for children, mothers, and fathers. Bonferroni post-hoc analyses revealed that PS children's and PS mothers' postoperative anxiety was lower than controls' postoperative anxiety. PS fathers' experienced greater preoperative anxiety than controls and no significant differences with control fathers emerged in postoperative anxiety. PS-based intervention emerged to reduce children's and parents' anxiety over time, and to diminish children's and mothers' postoperative anxiety in comparison with the controls.

Acute Appendicitis in Pre-School Children

Background: Appendicitis is an emergent condition in young children which can cause serious illness. Aim: To identify features related with appendicitis in pre-school children. Study design: Retrospective study Place and duration of study: Department of Paediatric Surgery, Bolan Medical College Hospital Quetta from 1st April 2020 to 31st March 2021. Methodology: Fifty two children between 5-15 years were admitted for appendectomy. All demographic and clinical information including earlier diagnosis, symptoms, biochemical, histopathological as well as radiological imaging were properly documented. The operational technique was open appendecectomy. Results: There were 61.53% boys and 38.46% girls with mean age 8±0.8 years. Abdominal pain was presented in 90.3% while nausea in 82.7% with nausea/vomiting children. There were 51.9% children having perforated appendix with majority between 8-10 years of age. Misdiagnosis was common in 44.2% patients. Conclusion: Appendicitis in pre-school children is difficult and challenging to diagnose which requires careful diagnosis. Key words: Appendectomy, Pre-schoolers, Perforated, Misdiagnosis